Provider Demographics
NPI:1235348939
Name:ROBERTS, PATRICIA LOUISE
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LOUISE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 REYNARD RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-5627
Mailing Address - Country:US
Mailing Address - Phone:501-821-3902
Mailing Address - Fax:
Practice Address - Street 1:20400 COLONEL GLENN RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72210-5323
Practice Address - Country:US
Practice Address - Phone:501-821-5500
Practice Address - Fax:501-821-5800
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR547C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical